Section 4.7

Psychiatric Nurse Practitioner

This section of the Prescribing Guidelines describes Nurse Practitioner prescribing practices, and supervision of their medication services by Behavioral Health Services Psychiatrists. The two primary references for this are the Nursing Practice Act - Sections 2725, 2746 & 2836 and the Orange County Standardized Procedures for Psychiatric Nurse Practitioners (NP).

The NP's prescribing of medications is called "furnishing." Medications are "furnished" when the Nurse Practitioner writes a prescription on an OC BHC prescription pad that has the NP?s furnishing number and the name and license number of a supervising psychiatrist. This "furnishing" does not require a co-signature by a MD. The NP obtained a "furnishing number" through training, required experience and licensure. A NP?s role should complement the role of the Psychiatrist. A NP?s training and role are briefly outlined below:

  1. A NP is an RN with an advanced degree in Nursing (i.e. MSN with Specialty in Psychiatry), has a certificate as a Nurse Practitioner, and has taken additional pharmacology courses in a Board of Registered Nursing approved NP training program. They will have this training before coming to work at OC BHC. NP?s with their furnishing number do not require any co-signatures from the clinic psychiatrist.
  2. NP may work in the clinic without a furnishing number. After a new NP without a furnishing number completes the first six months in the clinic, he/she may apply for his/her furnishing number. To obtain the furnishing number, the supervising MD(s) sign(s) one page of the application certifying that the six months of clinical experience did occur. NP?s without their furnishing numbers do require medication/ furnishing service entries and prescriptions to be co-signed. Once licensed with a furnishing number, there is no other signature requirements by the supervising MD.
  3. NP's operate within the scope of his/her nursing license, and additionally furnish drugs agreed upon in a written Standardized Procedure. The Standardized Procedure Manuals are in a binder kept in every NP and supervising MD?s office.

Supervision by Psychiatrist

  1. The NP's function is to assess and treat the "essentially healthy" (i.e., relatively stable) patient. Although, NP's are independently licensed, they also must have psychiatrist supervision.
  2. The supervising psychiatrist can be available by phone or in person on an "as needed" basis, as outlined in the Standardized Procedures. Any psychiatrist can consult without direct contact with the patient (no cosigning is required), or can see the patient and enter findings and recommendations into the medication record.